Separation from Employment Withdrawal Request …

Separation from Employment Withdrawal RequestGovernmental 457(b) PlanSTD FSPSRV ][05/11/17)(98993-01 WITHDRAWALNO_GRPG 58070/][GU22)(/][GP22 DOC ID: 483027898)(Page 1 of 16 CERF Savings Plan - 457 Plan98993-01 When would I use this form ?When I am requesting a Withdrawal and I am no longer employed by the employer/company sponsoring this Information For purposes of this form , the terminology ' Separation ' is the same as 'Severance', ' Employment ' is the same as 'Service' and ' Withdrawal ' is thesame as 'Distribution'. By logging into my account on the website at , I may confirm the address that is on file and track the statusof this Withdrawal Request . For questions regarding this form , refer to the attached Participant Withdrawal Guide ("Guide"), visit the website at or contact Service Provider at 1-800-701-8255.

Separation from Employment Withdrawal Request Governmental 457(b) Plan STD FSPSRV ][05/11/17)(98993-01 WITHDRAWALNO_GRPG 58070/][GU22][GP22DOC ID: 483027898 Page 1 of 16 CERF Savings Plan - 457 Plan 98993-01

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  Form, Employment, Request, Withdrawal, Governmental, From employment withdrawal request, From employment withdrawal request governmental 457

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